MEDICARE: DR. JOSEPH GERARD THIBAULT D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH2422	MA

General Provider Information

NPI Number	:	1922156199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GERARD THIBAULT D.C.

Provider Business Mailing Address
First Line	:	43 BROAD ST
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-2912
Country	:	US
Telephone Number	:	413-562-2600
Fax Number	:	413-562-8589

Provider Business Practice Location Address
First Line	:	43 BROAD ST
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-2912
Country	:	US
Telephone Number	:	413-562-2600
Fax Number	:	413-562-8589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	10/03/2012

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